Under the Knife: Harper's Knee, Weaver's Elbow, Buchholz's Shoulder and More

There's more than enough injuries to fill 20 slides this week. Big injuries to big names are good for my job security but bad for the game. Missing Bryce Harper, Clay Buchholz or David Price costs teams wins and dollars, but beyond that, the lack of effort in prevention and research is problematic for the future of the game. 

The old quote from Joe DiMaggio—"There is always some kid who may be seeing me for the first or last time, I owe him my best"—holds true here. Fans do come to see Harper play like his hair is on fire or to see the smooth swing of Ryan Braun. That they're missing games means that fans are missing out. 

The doctors and athletic trainers around baseball are doing all they can, but they're not given much support. The owners seem content to lose billions of dollars to the DL. Quick, tell me the last MLB-funded research initiative that you read about. (If you have one, please drop it in the comments because aside from the ongoing work on pitcher head protection, I can't think of one from the last 18 months.) 

There's another old quote, probably as apocryphal as DiMaggio's, that billionaires can look as stupid as they want because they can afford it. While true, you have to wonder how long the game can afford it. It's time that MLB as a whole tackled this issue, making prevention a strategy and letting the findings trickle down to the millions of baseball players at lower levels.

For the injuries that have already happened, let's get to it.

Bryce Harper (Knee)

It's easy to understand Bryce Harper running into a wall and missing time with a concussion...oh wait, not a concussion. Bouncing your head off the non-padded section of wall usually does lead to some time off. That's not been the problem for Harper, who missed more time last week with a knee issue. 

Was it the collision that caused the knee problem as well? It looks that way, given the diagnosis as currently given. The Nats told the Washington Post that the MRI came back clean, confirming their diagnosis of bursitis. 

Bursitis is the inflammation of one of the bursa sacs, small fluid pockets that act as cushion and protection for many joints in the body. They can be injured in collisions and if the sacs burst, they can be problematic if an infection occurs. Harper did seem to hit his knee in the collision and had no previous known problems. Occam's razor works well in baseball, so we'll go with the simple cause. 

The worry had been that Harper had a mild sprain or a small tear in the meniscus. A case of bursitis is easy to deal with given sufficient rest and a lack of stress on the affected area. The Nats seem to be handling this normally, though we know that the normal definition of rest is tough to enforce on someone like Harper.

Assuming there's nothing more, Harper should be back in the lineup consistently this week and shouldn't have much problem going forward. At least until next time he dives, runs into something or someone or strains something as he goes all out on every play. It's a strength and a weakness for now.

Clay Buchholz (Shoulder)

Have you noticed that suddenly we're getting a lot of discussion about collarbones and pitchers? It's not just Zack Greinke, who fractured his collarbone in a fracas earlier this year. Recently, two pitchers, Clay Buchholz and Zack Wheeler, have made the news due to "sore collarbones." It's an unusual designation and in these cases, it's misleading.

Both Buchholz and Wheeler actually had issues with their AC (acromioclavicular) joints. This is the joint between the shoulder itself and the collarbone, so the designation is understandable. The soreness is at the point of the collarbone, but it's still an issue of the shoulder.

The AC joint tends to get involved when there's inflammation leading to some kind of impingement. In the worst cases, surgery is necessary. The most common is called a Mumford, where the end of the collarbone is shaved down to create more space. 

Surgery isn't in the offing for Buchholz. In fact, he's expected to start this week, according to MLB.com. This would indicate that the soreness was transient and able to be cleared up by treatment. In Wheeler's case, he was examined, given a cortisone shot and returned to Triple-A Las Vegas, so it would appear that Buchholz's case wasn't even as concerning. 

The rest and treatment should help Buchholz, who is having a breakout campaign under John Farrell. If his shoulder stays healthy and this episode is an exception rather than a harbinger, Buchholz has a real shot at the Cy Young via the win route. Wheeler should be fine as well. His return has been positive with no further problems. He's expected to be called up by the Mets sometime in mid-June.

Mark Teixeira (Wrist), Curtis Granderson (Hand)

The Yankees' season has been defined by injuries. So far, they've been able to overcome them, letting Joe Girardi mix and match to a competitive record while being bolstered by pitching strength and depth. That will be tested again with comings and goings this week, with Mark Teixeira in and Curtis Granderson out once again. 

The Yankees are taking an intriguing path with Mark Teixeira. His strained wrist was treated conservatively up to this point, with the shift to the 60-day DL allowing them to take an almost leisurely pace and making sure that the tendon sheath had plenty of time to heal up. Now, the Yankees seem to be aggressive, planning only a two-game rehab assignment at nearby Double-A Trenton before bringing Teixeira back to the Bronx on Friday. 

The "two-game rehab" is a bit misleading. Teixeira is currently playing in XST, as he has been for over a week without any issues. If you believe that a swing is a swing, it's no different where he does it. Teixeira's wrist has shown no issues and had no major setbacks during this last phase of rehab. He's not showing much in the way of power, so look for that over this week and as he gets back on the big league field.

Curtis Granderson took another unlucky break, literally. Another inside pitch caught him on an unprotected hand, breaking a bone in the process. There's a lack of clarity on the exact nature of the break, with some saying it's the fifth phalange (pinky finger) and some saying it's higher, along the outside edge of the hand. In fact, it's the knuckle between them, making it understandable that there's some confusion.

Granderson should miss about a month with this and will face the same kind of questions when he returns. Hand injuries tend to cause grip-strength issues, leading to a bit less bat control and an increase in strikeouts. We'll get plenty of looks during Granderson's rehab to see if this will be an issue. 

Ryan Braun (Thumb)

The Brewers have yet another injury, though the thumb injury to Ryan Braun seems relatively minor. In fact, the number of injuries is misleading for the Brewers. Most of their injuries have been either traumatic or very difficult to prevent.

Where the medical staff has done well is in limiting the length of the injuries where possible. Of course, injuries like the knee problems of Corey Hart (who should be back in early June) and Mat Gamel will count against their injury stats at the end of the year all the same. 

Braun's thumb injury has been going on for a while, according to Adam McCalvy, and the day off was done in hopes that a bit of rest will help clear the issue up. While the details of the injury are vague, the description given by Braun indicates a bruise or minor sprain. Both would be painful but not problematic in the long term. 

Braun did come in for a pinch-hit appearance, so that's a positive sign, but it also shows that he didn't get the full rest intended. Watch to see if the Brewers try to buy him some extra rest over the next few weeks the way they have with Aramis Ramirez. Getting Hart, Ramirez and Braun all healthy will be easier if all are back, giving the lineup the power they bring and eventually getting Braun the rest his thumb could use to heal up.

Kyle Lohse (Elbow)

The saying goes that those who do not understand history are doomed to repeat it. Kyle Lohse has an extensive injury history, one that includes a very unusual episode that is now complicating what seems to be a simple inflammation situation in his pitching arm. 

In 2010, Lohse was forced to have surgery to correct the symptoms of exertional compartment syndrome. There are no other pitchers known to have had this kind of condition, one normally seen in motocross. Lohse had the surgery and returned well, but any sort of inflammation in the area has to be noted due to that previous episode. 

The Brewers never seemed too concerned about this injury, with Adam McCalvy getting Ron Roenicke to admit that Lohse's lack of spring training factored into the decision to delay the start. There has been no discussion of any injections, though any time you hear inflammation, it's safe to assume that a Medrol Dosepak or similar anti-inflammatory is being administered.

Lohse is expected to start on Thursday. It appears the minor inflammation will do nothing more than cost him one start and the Brewers a bit of rotation juggling. If the Brewers don't right the ship soon (and remember, they started very slow last year), we could see a lot more juggling, including some of the young pitchers they collected over the last few seasons.

David Price (Shoulder)

Playing catch doesn't sound like much. You and I could go out and have a catch right now, right? "Throwing session" sounds more official and important, but what it amounts to is having a catch. 

That's what David Price did on Monday, the first such session since he went on the DL with a triceps strain. He and Ron Porterfield, the Rays athletic trainer, made 35 tosses, according to Marc Topkin of the Tampa Bay Times. Throwing with the AT means its usually not that long, 60 to 90 feet, but gives a good look at how the player is throwing and reacting to those throws.

A fist bump may not be telling, but it's a small positive. Price has more work to do before returning, and his quick return goes against the instincts of the organization, even if things are pretty positive. The Rays tend to be very conservative with injuries, taking the extra time when possible to make sure that a player doesn't end up back on the DL. 

The fact that they have sick depth to cover Price's absence is another factor here. Getting Jake Odorizzi a quick cup of coffee at the majors gives them a look at their future in case Price is dealt in the next year. While everything is going well, do not expect any rush back to the rotation for Price. That's good for the Rays, bad for fantasy owners.

Jered Weaver (Elbow)

Jered Weaver returns on Wednesday for the Angels, skipping the expected rehab assignment. The Angels ace slotting right back in as the Angels try to surge back into relevance is good timing and a bit of a force.

Weaver has had no physical issues while returning from his fractured non-pitching elbow, though he did show some serious issues with command early on in his rehab. The glove-side elbow is involved in the normal mechanics of pitching and it appears to have been the root cause. 

In his XST start, Weaver was dominant and showed no command or mechanical issues, but doing that against very low-level comp is a far different thing than facing major league or even high minor league hitters. Weaver's first start against the Dodgers will be an interesting one. Watch to see if his long-lever mechanics are consistent by watching his glove's movement during the delivery.

The expectation is that Weaver will not have many issues in returning. He won't have a long leash, likely to be limited around 90 pitches, which shouldn't be too problematic given aggressive competition. Once he gets that back and shows his command isn't an issue, Weaver's injury is one we can forget about as there should be no real lingering effects.

Chris Sale (Shoulder)

Say what you will about Chris Sale. He's skinny as a rail. He has mechanics that appear awkward, all elbows and hard angles. He's had arm problems in the last two seasons, enough so that the team considered shifting him to the bullpen. You could also say that he's one of the most effective starters in the American League.

What it comes down to is that there's what we think we know and what we actually know about Sale, and the gap might be bigger than you think. While Don Cooper admits that Sale's mechanics are a problem, the issue they discussed with Mark Gonzalez of the Chicago Tribune is more about timing and rhythm than the kind of kinetics and kinematics that would be found in a biomechanical analysis (Sale has never had one). 

There's no end of untrained analysts out there expecting Sale's arm to blow up. Many might use the picture above as "evidence." It's easy to point to any pitcher that looks odd and guess, especially since 52 percent of pitchers will go on the DL in any given three-year period.

He's had issues for a while, but with Cooper and Herm Schneider's sorcery working for him, he's done pretty well so far. The Sox were even willing to give Sale a long-term extension, an indication that they feel comfortable with the long-term health risks. 

The shoulder tendinitis that cost Sale a start appears to have been cleared up. His Sunday side session went well and his Tuesday start will tell us more about where he's going. After last year's short shutdown, Sale cruised. It could just be that Sale needs the occasional skip, something modern pitching management needs to work on. 

Chris Perez (Shoulder)

Chris Perez's season has been focused on whether his shoulder has been healthy or not. He missed much of spring training with a strained shoulder but made it back in early April. Since then, Terry Francona and Lonnie Soloff have been forced to navigate the day-to-day availability of their closer.

Things are simpler now but worse. Perez is out, headed to the DL with a more significant diagnosis of rotator cuff tendinitis, according to the Indians. Given the previous diagnosis, this is about as good a diagnosis as could be expected. Tendinitis is treatable and does match up with the stop/start nature of Perez's problems so far. 

If this is more, a tearing or even a fraying of the cuff, Perez has a bigger issue, as do the Indians. Shoulder surgery is hardly an easy road back, even in best-case situations. While there's no indication that Perez is headed that direction just yet, we should watch to see that he doesn't miss more than the minimum and that his velocity is normal when he does return.

Vinnie Pestano will take over as closer for the Indians, but he's had injury issues of his own. The closer role may well end up a mix and match, something that Francona is not opposed to when necessary. 

Austin Jackson (Hamstring)

One of the things that throws people off is the term "15-day DL." The 15 days is a minimum, a roster construction, not an expiration date. Some players in the past have stayed on the 15-day for an entire season. Going past it is no big deal and in the case of Austin Jackson, it's the smart play.

Jackson's strained hamstring is making progress, but for a speed player like Jackson, making sure the hamstring is not just good enough but actually healed is a real key. If Jackson needs more than a few extra days to satisfy the medical staff that there's no chance of recurrence, he could also get a quick trip to Triple-A Toledo or Double-A Erie for a couple games' worth of at-bats. 

Jackson is just beginning to hit, but we've heard very little about his running. He's doing some, but he seems to be at least a week away from any sort of return and likely a bit longer. The Tigers are making do with their outfield depth while they focus on the longer term with Jackson. 

Matt Kemp (Shoulder)

Peter Gammons has a brilliant article about shoulder injuries and their effect on hitters. Gammons went to Dr. Neal ElAttrache to learn more and brought out some interesting facts about how these injuries are handled and then dug deeper to look at what it does to a player's production. It's not only must-read, but it's one where I'd encourage you to read it several times. 

Matt Kemp is one of the big examples in this article and his shoulder injury is still affecting him, despite or perhaps because of offseason surgery. Kemp has been flat awful lately, with Rotowire noting that before sitting out on Sunday, Kemp had struck out nine times in his last 15 at-bats. 

Kemp is simply not the player he once was, yet he's denying that the shoulder is the reason behind his poor performance at the plate. Whether he will be again or not depends on how he and the Dodgers handle things, but it's important to note in the future that hitters with shoulder problems are likely to be ones you want to avoid, even with top-level talent and top-level medical care.

To bring today's UTK full circle, it's this kind of tumble from MVP levels that Bryce Harper should note. One wrong dive, one more collision and any player could be felled, no matter how much talent.